MEDICARE: MRS. BEVERLY SUE BIETENDUVEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1467672469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEVERLY SUE BIETENDUVEL

Provider Business Mailing Address
First Line	:	4414 SCHULTE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-2040
Country	:	US
Telephone Number	:	513-921-2801
Fax Number	:

Provider Business Practice Location Address
First Line	:	4414 SCHULTE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-2040
Country	:	US
Telephone Number	:	513-921-2801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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